HIV/AIDS and International Exchange Planning
Learn more about policies, medication and accommodations planning, and personal and professional resources useful to international exchange travelers living with HIV/AIDS.
Introduction
Positive living is an attitude among people living with HIV/AIDS who take control over their own lives and their rights to information, health care, safety, support and dignity.
This tipsheet is intended to encourage people living with HIV/AIDS to consider taking part in an international experience, and to assist those who are already planning to travel abroad. It is also useful for international professionals, educators, and disability service professionals assisting this community.
This tipsheet includes:
The Americans with Disabilities Act and people living with HIV/AIDS
Vaccinations, medications and insurance preparation
Accommodations and services abroad
Personal stories of HIV positive travelers
About HIV/AIDS
The Human Immunodeficiency Virus (HIV) is transmitted through infected bodily fluids and attacks a person’s immune system, causing the body to be more susceptible to opportunistic infections. A person is said to have the Acquired Immune Deficiency Syndrome (AIDS) if his or her immune system is severely compromised as a result of HIV.
However, a person who is HIV positive may continue to look and feel healthy for years, even as the immune system becomes damaged, or they may experience effects of the virus such as cognitive, neurological, respiratory or vision changes, fatigue, light sensitivity, and weight loss, as well as vulnerability to opportunistic infections.
Many people are unaware that they have been infected with the HIV virus. To learn how HIV is transmitted, how to reduce risk of HIV transmission, how to get tested, and how to receive emotional and medical counseling from a reputable public health source, read the Center for Disease Control (CDC) Factsheets.
Although there is no cure for the virus, there are drugs that can slow down the progression of HIV to AIDS, and certain lifestyle behaviors, such as healthy eating and exercise, may also delay the onset of AIDS. Those who choose to travel abroad with a compromised autoimmune system need to plan strategies for minimizing exposure to contagions and for medical care in case they become ill.
The Americans with Disabilities Act and people living with HIV/AIDS
The Americans with Disabilities Act (ADA) recognizes persons with HIV, both symptomatic and asymptomatic, as persons with a disability. This means they are guaranteed federal civil rights protections and equal opportunities in public employment and services in the United States, including U.S.-based exchange programs. Learn more in the U.S. Department of Justice’s online factsheet.
A person does not have to be a U.S. citizen to be covered by the ADA if they are living in the United States, but an American going abroad may not have the same rights in the host country as they would in the United States. Travelers are encouraged to check the laws of the countries to which they will be visiting.
Visa and entry regulations
Coming to the United States
It is possible for people living with HIV/AIDS to enter the United States. As of January 4, 2010, non-U.S. citizens “will no longer be inadmissible into the United States based solely on the ground they are infected with HIV, and they will not be required to undergo HIV testing as part of the required medical examination for U.S. immigration.” This means that non-U.S. citizens with HIV/AIDS are equally likely to be granted entry as those who do not have HIV/AIDS, so long as they meet other entry criteria.
Only medications that can be legally prescribed in the United States may be imported for personal use, and as a general rule, the U.S. Food and Drug Administration does not allow the importation of prescription drugs that were purchased outside the United States. Visit the FDA website, and its page on The Importation of Drugs into the United States, for information about the enforcement policy for personal use quantities.
At customs, people entering the United States with prescription medication must declare any prescription medication containing potentially addictive drugs and narcotics. All drugs must be properly identified and in a quantity that is no greater than what the traveler will require while abroad. Bring a current prescription or a doctor’s certificate in English stating that the drugs are being used under a doctor’s direction and are required for physical well-being while traveling. Learn more on our Medications and International Travel. The U.S. Customs and Border Protection has a general set of regulations for bringing medications into the United States, as well as an incomplete list of prohibited and restricted medications, posted on the CBP website.
Americans Traveling Abroad
Americans traveling abroad should leave detailed information about travel plans with a friend or family member and consider registering travel plans with the U.S. Department of State, so the embassy can locate and assist them more quickly in case of an emergency.
Unlike the United States, some countries bar or restrict entry for people living with HIV/AIDS, while others may not have any known or consistent policies in place that deny or approve travel based on HIV status. Entry into countries with certain restrictions may depend on the length of stay in the country or special circumstances. Allow extra time for researching visa requirements for the specific country.
You can also find a country’s laws pertaining to HIV/AIDS and relevant organizations within the country at the Global Criminalisation Scan, a clearinghouse on HIV laws at the national level worldwide. It is also advised to be in touch with local organizations in the destination country of people living with HIV/AIDS that can be found through the The Global Network of People Living with HIV/AIDS.
Vaccinations, medications and insurance preparation
People who are HIV-positive can and do travel internationally. In fact, a Canadian survey reported that 133 HIV-positive study participants out of 290 had traveled internationally in the five years before the survey – almost half! However, of these participants, many had not sought health advice or travel clinic advice and showed poor compliance with antiretroviral regimens while traveling. Such behaviors may explain why HIV-positive travelers tend to have an increased risk of illness while traveling. To reduce this risk, international travelers living with HIV should take full advantage of pre-travel counseling, including information on safer sex, vector-borne diseases, immunization, border-crossing issues and adherence to drug therapy. Read the full study “Travel patterns and risk behaviour of HIV-positive people travelling internationally” online.
Vaccinations
In addition to national laws and policies on HIV/AIDS, also consider the health risks associated with particular regions when selecting a destination country and whether these risks warrant a vaccination or series of vaccinations to protect against diseases such as yellow fever, hepatitis, and other diseases. Less-developed countries pose a considerably greater risk to people with compromised immune systems due to increased poverty and fewer medical and public health resources. The Center for Disease control strongly discourages those with severe immune compromise from traveling to areas prone to yellow fever, and cautions that malaria infection can lead to an increased HIV viral load, exacerbating disease progression.
Knowledge of the HIV-infected traveler’s current CD4 lymphocyte count is a crucial part of pre-travel consultation. Talk to a primary or specialty care provider to determine whether one’s immune status will affect which vaccinations can be safely taken. Refer to the Center for Disease Control’s “The Immunocompromised Traveler,” in its Traveler’s Health Yellow Book to find vaccine recommendations for travelers of varying degrees of immunocompetence. Here, you will also find information on how other travel-related medications, such as anti-malarials or antibiotics against travelers’ diarrhea might potentially interact with HIV drugs. View a slideshow on other drug and medical care issues at the HIV travel restrictions and retreats “Traveling with HIV” website.
Other resources:
Medication & other travel preparations (UK website)
Immunizations for HIV-Infected Adults and Adolescents
Medications and International Travel
Medications
When traveling with medications, everyone can follow some simple advice to minimize the chances of customs delays or deportations:
- Keep all medications in the original packaging, and don’t try to hide them.
- Bring a doctor’s certificate or letter that states that the medications are administered under doctor’s direction and that they are required for one’s physical well-being.
- Keep a copy of the prescription with the medicine, and a copy in another safe place.
Remember that some of HIV medications are sensitive to environmental conditions, and may either need to be kept at room temperature or refrigerated. Considering that airplane cargo compartments are unpressurized and unheated, take special care to protect the integrity of medications while in transit. A carry-on bag may be the best place for your medication, especially since there’s always a chance that checked luggage will get delayed or lost.
Packing one’s own supply of syringes or needles is a good idea if injections are required while abroad, especially when traveling to less-developed countries where individually-wrapped sterile equipment may not be available. Check with the U.S. consulate in the destination country about local practices and regulations regarding the use of syringes and needles. Also find out in advance whether the airline has a policy on carrying these items. Remember to include a letter from a doctor that states the need to have them for a medical condition.
The HIV travel restrictions and retreats “Traveling with HIV” website has advice for carrying needles and syringes, scheduling in-flight injections, adjusting medication schedules to time zone changes, and not changing your medication routine.
Insurance
If one’s existing insurance will reimburse for services rendered overseas, then this is the best option in keeping coverage while abroad. However, purchase of supplemental travel health insurance may also cover other aspects, such as medical evacuations. In situations where the medical condition is declared and discussed with the insurer in advance, some travel policies may provide HIV/AIDS inclusion clauses, but cost more than standard premium rates. Potential policyholders with HIV may be offered single trip coverage or annual trip insurance to have medical coverage while they are abroad. Countries with national health plans, such as the United Kingdom, do have some travel health insurance policies specifically for those traveling with HIV/AIDS whose conditions are stable. Resources for insurance coverage for UK residents can be found at HIV Travel Restrictions and Retreats Travel Insurance webpage or All Insurance Info on HIV and Insurance website.
Keep in mind that individual travel health insurance agencies may deny enrollment, exclude coverage needed for HIV/AIDS if it meets the definition of pre-existing condition by the policy, and/or require advanced purchase or a more expensive plan for pre-existing condition coverage if a traveler can show they are “medically able” or “not disabled from travel”.
The existence of HIV does not equate to it being considered a pre-existing condition, since an individual may be stable and healthy prior to coverage and not receiving ongoing care. If the pre-existing clause prevents coverage – or only provides limited coverage - check if pre-existing conditions related to HIV/AIDS would be covered in an emergency to stabilize an a condition or cover medications if they remain controlled without any change.
Find more detailed information in our tipsheet on Insurance Considerations for Exchange Participants with Disabilities. This tipsheet includes web search engines for finding U.S.-based travel health insurance agencies.
Accommodations and services abroad
For people with HIV/AIDS traveling to the United States:
In the United States, HIV/AIDS is one of the most publicized yet also one of the most misunderstood issues. HIV/AIDS still carries a stigma although it affects Americans of all backgrounds. Advocacy groups are working across the U.S. to both change perceptions and protect the rights of people living with HIV/AIDS. There are also educational, social and support groups in every U.S. state.
Antiretroviral treatment is available in the United States, but the level of accessibility varies across a number of economic and other barriers. For foreign nationals, regular care will be self-pay, unless their country of residence has a mechanism for paying for out of country care or they are able to obtain travel health insurance that provides coverage. In emergency situations, emergency rooms in the United States cannot turn away any patient in need of care, including people with HIV (see the section on ADA, above). However, emergency care is extremely expensive, and only in some cases would it be covered by federal emergency Medicaid.
Learn more on the Averting HIV & AIDS website on “HIV and AIDS in America” and Treatment and Care for AIDS in America.
For people from the United States with HIV/AIDS traveling abroad on an international exchange program:
Many international education programs will require participants to submit a health form describing their medical history. Disclosure of HIV/AIDS should not be tied to the admission process as organizations in the U.S. are prohibited from considering disability as an admission criteria. When choosing whether to disclose HIV/AIDS, applicants should consider asking the program provider questions such as, “Who has access to this information in the United States and in the host country? Is there a process for medical approval? What is it?”
Also think about what preparations need to be made to travel to the host country such as finding a health care provider and learning about the availability of certain medicines in case of an emergency. If the program provider is aware of the need to prepare well in advance, staff can assist in finding and assessing resources abroad. Staff may also be able to give insight into local norms and attitudes regarding people who are HIV positive. For more information about disclosure of non-apparent disabilities see the tipsheet Disclosure: When and Why to Disclose a Disability for an International Exchange Program.
Although information on accommodations while abroad will largely be specific to the destination country, general health and safety precautions can be followed from The Council on International Educational Exchange’s page on “AIDS and International Travel”:
- Some countries may not have the resources to adequately screen blood or provide sterile needles. Again, bring a syringe kit if there is doubt about the quality of sanitation in the destination country, and include the doctor’s certificate.
- Some countries may require HIV antibody tests, a test for antibodies to HIV that causes AIDS. Check with the exchange program to learn whether a test will be required.
Although U.S. consulates provide lists of physicians who treat HIV/AIDS patients in various countries, they cannot recommend specific doctors. However, American consular officials can help travelers get in touch with emergency contacts back home in case of an emergency.
To learn more about and connect with organizations and group of people living with HIV/AIDS in the host countries, The Body: The Complete HIV/AIDS Resource lists international HIV/AIDS organizations.
HIV/AIDS in other cultures
Nearly every culture has its own cultural norms, attitudes and beliefs towards HIV/AIDS, including the United States and its subcultures. Keep in mind that HIV/AIDS may not be recognized as a disability in other countries and that people with HIV/AIDS may be stigmatized. Depending on the country, HIV/AIDS may be a taboo subject that is not polite to talk about, or it may be the focus of a national awareness campaign. Take time to learn about the culture of HIV/AIDS in the destination country before departure. Keep the cultural context in mind when considering whether, how, when, and to whom to disclose.
For information on additional stigmas or risks for people with physical, sensory (deaf, blind), intellectual and mental health disabilities living with HIV/AIDS worldwide, read articles on the HIV/AIDS and Disability Global Survey website.
Common misunderstandings about HIV/AIDS
The HIV/AIDS Awareness and Disability Rights Training Manual from Rehabilitation International states “there are common misunderstandings about HIV/AIDS, which are difficult to get correct because they are widespread in society. Some of these misunderstandings come from traditional beliefs, including:
- Belief that the HIV virus is the result of sin
- Belief that white people brought HIV/AIDS to Africa
- Belief that HIV is in condoms
- Belief that HIV is punishment from God
- Belief that Muslims do not get HIV
- Belief that sexual intercourse with a virgin will cure AIDS
Assumptions about a person’s sexuality, lifestyle, and capability may also develop as a result of knowing that person’s HIV status. People who understand little about how HIV is actually transmitted may avoid those living with HIV/AIDS for the mistaken belief that casual contact can spread HIV.
While researching treatment facilities for physical health while abroad, don’t neglect mental and emotional health in adjusting to a new culture or environment far from usual support systems. Arrange an emotional support network of friends, family, or program staff to confide in. See our Mental Health-Related Disabilities: Considerations for International Exchange Participants tipsheet for useful planning strategies in preparing for cultural adjustments or declining health abroad.
Language
Foreign language dictionaries don’t always include medical terms. Research HIV/AIDS-related terminology, abbreviations, and informal jargon (slang) in the host language. For example, in French, AIDS becomes le SIDA and HIV becomes VIH. Try doing a search for “HIV” or “AIDS” on Wikipedia.org and then select the host language in the left sidebar to get a feel for what terms are used.
Additional language resources include:
- Multilingual HIV Treatment Information Glossary in several languages (Chinese, French, Hausa, Punjabi, Swahili, Tagalog, Tamil, Vietnamese and English).
Personal stories of HIV positive international exchange travelers
Carlton Rounds, who has spent time in many countries on many continents, recognized a need for support for HIV positive or affected people away from home to do service projects abroad. To help bridge that need, Carlton established Volunteer Positive, which empowers people living with HIV to be engaged global citizens by creating service opportunities through partnerships abroad.
Additionally, Volunteer Positive supports training and education for international volunteer organizations committed to proactive inclusion for people living with HIV. Volunteer Positive members are people whose lives have been affected by HIV, who are committed to human rights, and who have a deep passion for international service. Join the Forum at Volunteer Positive to learn more and stay up to date.
Advice from HIV+ Peace Corps volunteers
Jeremiah Johnson became infected with HIV while serving in Ukraine as a Peace Corps volunteer and as a result, the Peace Corps medically separated him, meaning that Jeremiah was judged unable to return to his assignment. Fortunately, the Peace Corps now reports that "the question of whether a particular Peace Corps Volunteer is returned to the U.S....will depend on an individual assessment..." and on the "specific facts of each case" (Source: Peace Corps Letter Acknowledging Policy Change, 2008, American Civil Liberties Union website). In an interview, Jeremiah discusses the feelings of loneliness that contributed to his unsafe sexual encounter, gay stigma in Ukraine, and finding moral support from friends back home. Read Jeremiah’s story “Service Interruption” online in the POZ magazine.
Jeremiah’s story reached another Peace Corps volunteer, Elizabeth Tunkle, who, upon disclosing that she had been infected with HIV while serving in Zambia, was evaluated and told that she’d have to be separated. However, only a month later the program contacted her at home to clear her for return to Africa, perhaps because of people like Jeremiah who had challenged the policy earlier that year. Life in Lesotho, where Elizabeth had been reassigned, took an emotional toll on all of the volunteers stationed there, but Elizabeth had the added burden of keeping the HIV infection a secret, which led to her feeling isolated from the other volunteers. Part of this weight was lifted when she shared her story not only with the other volunteers, but with HIV positive Basotho (citizens of Lesotho) as well. Though she had dark days, she credits the sense of support from the community as well as her renewed sense of purpose as helping her fulfill her service. Elizabeth’s story was posted online by Idealist.org.
Michael, an AIDS activist and Peace Corps alum, became infected with HIV after his volunteer service, but has since continued to travel in the developing world. When his friend asked about getting and taking his medications while in some of the remote areas he visited, Michael said he took a supply to last a couple of months along and was never more than a couple of days away from a town where HIV medication was available. In future travels, Michael will probably keep his HIV status private, citing potential security issues.
Another Peace Corps alum, Craig, served in West Africa before becoming infected with HIV. Since then, he has returned to his Peace Corps assignment site in Africa and has also visited Latin America. Craig brought extra supplies of medications along for each trip and was confident about getting additional medications if he ran out. Regarding opportunistic infections and diseases, Craig feels that travel to much of Africa and some other parts of the developing world could be too risky for people with HIV. Fortunately, the Peace Corps operates in several countries where the risk of such opportunistic diseases is minor.
Both Michael and Craig are friends of the editor at the Lesbian, Gay, Bisexual and Transgender US Peace Corps Alumni site.
International resources
- Can provide advice and support in the event of a legal crisis or health emergency.
The Global Network of People Living with HIV/AIDS
- HIV self determination organization with worldwide connections
Although efforts have been made to ensure accuracy, MIUSA/NCDE cannot be held liable for inaccuracy, misinterpretation or complaints arising from these listings. Mention of an organization, company, service or resource should not be construed as an endorsement by MIUSA/NCDE. Please advise NCDE of any inaccuracies you may find.
